Laparoscopic Deloyers Procedure for Rare Synchronous Colon Cancer

Abstract

Aim: To report a rare case of synchronous colon cancer involving the midtransverse colon and mid sigmoid colon who underwent totally laparoscopic resection and reconstruction by Deloyers procedure. Presentation of the Case: 62 year old male, known diabetic and hypertensive presented with blood in stools, occasional pain abdomen and weight loss since 6 months. On evaluation he was diagnosed as a case of adenocarcinoma involving midtransverse and mid sigmoid colon. He underwent laparoscopic left extended colectomy with ascending colon- rectal anastomosis by Deloyers technique. Discussion: Synchronous colorectal cancers accounts for 1-8% of all primary colorectal cancer. After extended left colectomy, it may be difficult to take down a well-vascularized colon into the pelvis and perform a tension-free colorectal or coloanal anastomosis. The Deloyers procedure comprising complete mobilization and rotation of the right colon while maintaining the ileocolic artery may be used in these circumstances. In our case the synchronous cancer was detected at the time of colonoscopy and it involved transverse and sigmoid colon. The surgery was performed by totally laparoscopic approach without extra incision for the retrieval of specimen. The specimen was retrieved through the ileostomy site. There was no compromise in oncological clearance and adopting Deloyers procedure helped to create a tension free colorectal anastomosis. Conclusion: Laparoscopic Deloyers procedure after extended left colonic resections for synchronous colon cancer is technically demanding, but safe and feasible in experienced hands.